There is controversy over how best to treat patients after they’ve undergone surgery for prostate cancer. Should clinicians wait until the cancer comes back or provide men with additional radiation therapy to prevent cancer recurrence? Now a new study, sponsored by the genomics diagnostics company GenomeDx and published recently in the International Journal of Radiation Oncology*Biology*Physics, shows that a genomic tool can help doctors and patients make a more informed decision.
Although surgery for prostate cancer is meant to be curative, in some men, the cancer can regrow. Doctors have developed high-risk criteria based on clinical factors, but these criteria are imperfect predictors of recurrence. Only about 50% of high-risk patients go on to develop metastases, raising the question of whether many who receive additional therapy are being overtreated.
In an attempt to better understand how to treat the patient population, researchers assessed whether a genomic test designed to predict prostate cancer metastasis could also predict which patients would most benefit from radiation treatment after surgery. The test, called Decipher, from GenomeDx, generates a gene signature from a patient’s cancer tissue sample. Based on this signature, the test stratifies patients into high, intermediate, and low risk for recurrence and metastases.
The researchers tested the genomes from tumor samples of 139 patients who had received radiation therapy following surgery. Using medical records, the researchers grouped the patients by the treatments they received after surgery, and matched their records to the results of the genomic analysis.
The genomic analysis correctly predicted outcomes. Patients with a high Decipher score were more likely to develop metastases than those with a low score. In addition, those with a high Decipher score who received radiation earlier had longer survival than those who did not receive radiation immediately after surgery. Read the study.
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